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General NPI Number Information
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NPI Number | 1306052634
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Entity Type | Organization
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Legal Business Name | NORTH TRAIL CHIROPRACTIC CLINIC INC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 4530 TAMIAMI TRL N SUITE 2
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City | NAPLES
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State | FL
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Zip | 34103-3011
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Country | US
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Telephone | 239-261-5222
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Fax | 239-261-5222
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Provider Business Mailing Address
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Address Line | 4530 TAMIAMI TRL N SUITE 2
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City | NAPLES
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State | FL
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Zip | 34103-3011
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Country | US
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Telephone | 239-261-5222
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Fax | 239-261-5222
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID ALAN DISHAUZI
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Credential | D.C.
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Telephone | 239-261-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH7182
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License Number State | FL
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